Provider Demographics
NPI:1104586171
Name:CHAMBERS, ANDREW DAUGHTON (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DAUGHTON
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 LAKE NORRIS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:39092-9511
Mailing Address - Country:US
Mailing Address - Phone:160-139-8763
Mailing Address - Fax:
Practice Address - Street 1:1314 19TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4116
Practice Address - Country:US
Practice Address - Phone:601-732-6301
Practice Address - Fax:601-732-2777
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily